TONSILS AND PHARYNX, DIS EASES 01'.
Acute Tonsillitis.
Acute tonsillitis, inflammation of the tonsils and adjacent structures, may be phlegmonous or croupous.
Symptoms.—Phlegmonous (or follicu lar) tonsillitis is ushered in by a feeling of dryness and stiffness in the throat, soon followed by dysphagia. There may be a chill, or chilly sensations, and pain in the legs and back, headache, and fever, which during the height of the disease may reach 106°. As the in flammation progresses, the sufferings of the patient become severe, the dryness of the throat causes frequent attempts at swallowing saliva. which are exceed ingly painful. In the phlegmonous variety the mouth can be opened only with pain and difficulty, and speech be comes almost unintelligible. The tongue is heavily coated and the breath ftutid. The hearing is frequently blunted from extension of the inflammatory process to the Eustachian tubes, and abscess of the ear sometimes results. Nasal breathing is at times entirely abolished. The fever, pain, and difficulty of swallowing be come greater and greater, if an abscess is forming, and the relief is proportion ately great after it has opened. As the patient expectorates the pus, he feels al most well, so great is the sense of relief, the fever and pain quickly subsiding together.
Etiology and Pathology.—An attack of phlegmonous tonsillitis is usually the result of exposure to cold and wet; but a person who has once had the affection is more liable to subsequent attacks. The rheumatic or gouty diathesis also plays its part in the production of at tacks of acute tonsillitis. And this is also true of chronic inflammation of the crypts of the tonsils, with accumulation of their secretions. It is by inoculation of the cellular tissue by such retained and decomposed masses that peritonsillar ab scesses are caused, for abscess rarely oc curs within the tonsil itself as the result of acute tonsillitis. Phlegmonous ton sillitis is a disease of adolescence and early adult life, and does not frequently attack individuals who are over thirty five years of age.
In croupous tonsillitis the brunt of the inflammation is at first borne by the crypts of the tonsils, which pour out an abundant cheesy secretion, which, ad hering to the surface of the tonsil, pre sents somewhat the appearance of a diph theritic membrane.
Acute tonsillitis due to the infection of the streptococcus pyogenes and the staphylococcus pyogenes albus and anreus, is characterized histologically by a dill use inflammation of the parenchyma of the organ, appearing in the form of an increased proliferation of lymphoid cells and of the endothelial cells of the reticu lum, due probably to the absorption of a toxin formed in the crypts. While bac teria are rarely demonstrable in the ton sillar tissue in cases characterized by purely proliferative lesions, yet at times infection of the interior of the follicle occurs, giving rise to circumscribed sup puration and the formation of abscesses which eventually discharge into the crypts. Coodale (Jour. Boston Soc. of Med. Sciences, Jan., '99).
Follicular tonsillitis is not caused by a single microbe, but many well-known micro-organisms are capable of causing it. The symptoms of tonsillitis are partly caused by an exaggeration of its func tion. Under the stimulus of infection the lymph-corpuscles in the adenoid structure of the tonsil produce an anti toxin that is antagonistic to invading germs. The characteristic symptom is an exudate having no texture and non adherent. The presence of the Klebs Loeffler bacillus is not positive evidence that the disease is not a simple follicular tonsillitis. There seems to be some rela tion between follicular tonsillitis and the infections diseases which is not yet prop erly understood; whatever the function of the tonsil, it seems in disease to en deavor by its activity to assist Nature in eliminating infection. R. C. Brown (Medical Record, March 1, 1902).